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Neurosurgery Could Spread Protein Linked To Alzheimer's, Study Finds (theguardian.com)

Posted by BeauHD on from the safety-first dept.

An anonymous reader quotes a report from The Guardian: Surgical instruments used in brain operations should be treated to ensure they are not contaminated with proteins linked to Alzheimer's disease, according to scientists who found evidence that they may be spread by certain medical procedures. The researchers urged doctors to decontaminate neurosurgical tools more thoroughly as a precautionary measure to reduce the potential risk of spreading abnormal proteins known to build up in the brains of Alzheimer's patients. Prof John Collinge, director of the Medical Research Council prion unit at University College London, said that while Alzheimer's disease was not contagious, there was a slim risk that harmful proteins that drive the disease could spread through brain surgery and other rare procedures.

63 comments

  1. I thought that with 3D printers by Anonymous Coward · · Score: 0

    we could just make new instruments every time?

    1. Re:I thought that with 3D printers by FormOfActionBanana · · Score: 1

      They couldn't really be sterile, could they?

      --
      Take off every 'sig' !!
    2. Re:I thought that with 3D printers by Anonymous Coward · · Score: 0

      Prion Diseases are not technically alive. They are deformed proteins that stable. normal disinfection methods are utterly useless unless you practically melt with heat corrosive.

    3. Re: I thought that with 3D printers by Anonymous Coward · · Score: 0

      Bleach does it, I think

    4. Re: I thought that with 3D printers by Anonymous Coward · · Score: 0

      Windex.

  2. But Ben Carson... by Anonymous Coward · · Score: 0, Flamebait

    was head pediatric neurosurgeon for almost thirty yeas at Johhns Hopkins.

  3. Protein? by PopeRatzo · · Score: 1, Funny

    Please excuse what is probably a dumb question, but I don't know biology. When they say this protein could be "spread", is it like a bacteria or virus?

    I read another article about Alzheimers that I didn't really understand that talked about researchers following the possibility that it is bacteria-based. Is this related to that? If I wasn't halfway into my third beer, watching the football game, I might try to figure it out, but I doubt I'd get very far unless one of you kind Slashdot souls helps me.

    --
    You are welcome on my lawn.
    1. Re:Protein? by Anonymous Coward · · Score: 3, Informative

      They're suggesting that Alzheimer's spreads like a prion disease once started.

    2. Re:Protein? by Anonymous Coward · · Score: 1

      The shape of a protein determines a lot of its characteristics and effects. A protein could have different shapes depending on how the elements that make it up are linked, and how its folded. Sometimes a misfolded protein can encourage other proteins of the same kind to misfold themselves. These misfolded proteins are called prions, and are usually very stable which means they are difficult for the body to get rid of. They're also difficult to destroy in the environment.

      Naturally we evolved some capability to deal with prions, there are cellular processes dedicating to getting rid of proteins that are no longer needed. Its often some combination of these malfunctioning along with exposure to a pathogenic prion that ends up causing a particular prion disease.

    3. Re:Protein? by msauve · · Score: 4, Informative

      "When they say this protein could be "spread", is it like a bacteria or virus?"

      Google "prion".

      --
      "National Security is the chief cause of national insecurity." - Celine's First Law
    4. Re:Protein? by PopeRatzo · · Score: 1

      Google "prion [wikipedia.org]".

      Thank you, friend.

      --
      You are welcome on my lawn.
    5. Re: Protein? by Anonymous Coward · · Score: 0

      Specifically, Reparative Therapy. You can be cured.

    6. Re:Protein? by Anonymous Coward · · Score: 1

      Creutzfeldt-Jakob disease (CJD) is the human equivalent of Mad Cow disease. It is caused by prions, where defective proteins invade the brain and induce other prion protein molecules to misfold in a self-sustaining feedback loop. It can be transmitted by surgical instruments or eating contaminated tissue, and there is no easy way to sterilize it.

      The researchers are suggesting that cerebral amyloid angiopathy (CAA), a condition similar to Alzheimer's disease, could be spread by amyloid and tau proteins on surgical instruments and transfusions. Mice that were modified to make human amyloid beta proteins and injected with the CJD-contaminated hormone developed clumps of amyloid beta and cerebral amyloid angiopathy.

    7. Re:Protein? by ShanghaiBill · · Score: 3, Informative

      Prions are misfolded proteins that appear to catalyse other proteins to misfold in a chain reaction. "Mad Cow Disease" and CJD (mad cow disease for humans) are the most well known types. It is not clear if Alzheimer's is caused by, or related to prions, but that is one hypothesis.

      The point of TFA is that normal sterilization techniques such as heat, alcohol, or chlorine bleach, work fine on bacteria and viruses, but may not destroy prions. Proteins can be much tougher than DNA. We may need to use higher heat and/or harsher chemicals.

      Here is a joke my daughter told me after she had a big fight with her boyfriend:
      Her: Why don't men get mad cow disease?
      My: Why?
      Her: Because they're pigs.

    8. Re:Protein? by dunkelfalke · · Score: 2

      That implies that women are cows, though.

      --
      "It's such a fine line between stupid and clever" -- David St. Hubbins, Spinal Tap
    9. Re:Protein? by pereric · · Score: 1

      No.

    10. Re:Protein? by MikeRT · · Score: 1

      Thank you, friend.

      "Anytime, buddy!" - Google

    11. Re:Protein? by Anonymous Coward · · Score: 0

      When they say this protein could be "spread", is it like a bacteria or virus?

      I read another article about Alzheimers that I didn't really understand that talked about researchers following the possibility that it is bacteria-based.

      Simplified to layman terms: Proteins are made by RNA in bacteria, virus and cells, since Prions are a type of protein anything with the right RNA 'recipe' could make the prion. Think of RNA as like metal die cutter. So in the same way bacteria, virus and cells can make any Protein if they have the right RNA sequence, Pions can too. Since Pions are not broken down naturally, and they can also act in reverse to make the RNA sequence, they can replicate themselves. So while they are not Bacteria or Virus, but they can replicate using the same underlying process as life.

    12. Re:Protein? by HiThere · · Score: 1

      Well, they're considering the possibility that it might be prion based. Nobody knows what causes it, and mis-folded proteins can't be ruled out.

      So far the evidence supporting the idea that it's prion based is quite weak, but promising approaches seem to keep failing. So it's unreasonable to just dismiss the idea.

      --

      I think we've pushed this "anyone can grow up to be president" thing too far.
    13. Re:Protein? by Anonymous Coward · · Score: 0

      Why do they call it PMS?

      Because mad cow disease was already taken...

  4. Creutzfeldt-Jakob Disease by LagFlag · · Score: 5, Interesting

    This has been an issue for years since the recognition of Creutzfeldt-Jakob Disease as a prion disease. Hospitals are more and more moving to disposable equipment, although this is not yet possible for neurosurgical instruments. Special cleaning procedures are already in place for surgeries having a high risk of contamination.

  5. Deja Vu by phaserbanks · · Score: 3, Informative

    Almost identical Guardian article from 2015.

    https://www.theguardian.com/sc...

  6. pernicious: an apt term for prions by swell · · Score: 4, Interesting

    Not sure why they left out the more ominous method by which these proteins can spread: eye surgery. Eye surgery is fairly common and not normally associated with such grave dangers. Those affected by these proteins (they are called 'prions'), invariably have them living in optical neural tissues. Surgeons, who may schedule multiple operations per day, need to find a better way to sterilize their instruments as the proteins are resistant to normal techniques. These discoveries seem to be new for some reason.

    This has been my first opportunity to use the word 'pernicious', an exquisite word that has somehow escaped my notice until today. Thank you, dear Slashdot readers, for allowing me this occasion.

    --
    ...omphaloskepsis often...
    1. Re:pernicious: an apt term for prions by mentil · · Score: 1

      Can't spell 'pernicious' without 'prions'.
      Or 'Prius' for that matter...

      --
      Corruption is convincing someone that the selfless ideal is the same as their selfish ideal.
    2. Re:pernicious: an apt term for prions by Gilgaron · · Score: 1

      Interesting... I'd have thought eye surgery would involve disposable blades due to the sharpness required, which instruments get reused?

    3. Re:pernicious: an apt term for prions by HiThere · · Score: 1

      Sorry, but you've been affected by selective reporting (at multiple levels).

      Prions are necessary for life. Much of the dry intra-cellular fluid is prions. Not all proteins are built initially in the active form, they often need a chaperon to cause them to fold correctly. These are prions just as much as the ones that cause incorrect folding. And without it no mammalian, I suspect no eucaryotic, life would exist.

      For more details you need to consult a real expert, I'm just a sometimes interested layman, (A real expert would know which phyla require prions to live. My suspicion that it's the eucaryotes, and only the eucaryotes, is based on quite uncertain reasoning.)

      --

      I think we've pushed this "anyone can grow up to be president" thing too far.
    4. Re:pernicious: an apt term for prions by Anonymous Coward · · Score: 0

      Etymology and pronunciation. The word prion, coined in 1982 by Stanley B. Prusiner, is a portmanteau derived from protein and infection, hence prion, and is short for "proteinaceous infectious particle", in reference to its ability to self-propagate and transmit its conformation to other proteins.

    5. Re:pernicious: an apt term for prions by HiThere · · Score: 1

      The useful ones are exactly the same as the deleterious ones except in the particular way they fold a particular protein. They are equally infectious. They are equally proteinaceous.

      --

      I think we've pushed this "anyone can grow up to be president" thing too far.
    6. Re: pernicious: an apt term for prions by Anonymous Coward · · Score: 1

      And you just might be wholly wrong

  7. How by Anonymous Coward · · Score: 0

    How do you study medicine for long enough to become a brain surgeon and then have to be told to decontaminate your instruments properly?

    How does that happen?

  8. How clean is clean enough for brain surgery? by drew_92123 · · Score: 1

    If they're concerned about the spread of proteins then they aren't properly cleaning their instruments to begin with. Anything that can't be put in an autoclave or cleaned using chemicals that break down organic matter completely should be disposed of.... the fact that this isn't happening already, especially for brain surgery, is deeply concerning.

    1. Re:How clean is clean enough for brain surgery? by dex22 · · Score: 4, Informative

      The problem with your statement is that prions survive autoclaving and generally require incineration at temps exceeding the melting point of most surgical metals.

    2. Re:How clean is clean enough for brain surgery? by Anonymous Coward · · Score: 0

      With what they charge patients/insurance for surgery and every little thing used (and often things that were never even used but were on-hand in case they needed them) all marked up by 25000%, ($20 band-aid, $25 gauze pad, $500 scalpel, or whatever) I'm completely flabbergasted that they re-use surgical instruments at all. I would have thought they stopped re-use 2 decades ago with the mad cow disease scare.

    3. Re:How clean is clean enough for brain surgery? by guruevi · · Score: 1

      Some surgical instruments cost a lot of money. A simple micro instrument could cost ~$1000. If you need to throw them out, you're looking at padding the bill by another $50-100k.

      --
      Custom electronics and digital signage for your business: www.evcircuits.com
    4. Re:How clean is clean enough for brain surgery? by Anonymous Coward · · Score: 0

      They are not inherently expensive though - they're only expensive because only 50 of a particular device have ever been made, and the cost has to cover the years of research that went into the design of the tool.

      At the end of the day, they're just metal bent and cut into fancy shapes. You could make them for a couple of cents each if the demand was high enough.

    5. Re:How clean is clean enough for brain surgery? by HiThere · · Score: 1

      Wellllll.....
      At the end of the day, they're just specialized alloys of metal bent, cut, and specially heat-treated into fancy shapes. You could probably make them for less than $100 each, if the demand was high enough.

      But "high enough" means a continuously active production line, that you don't shut down every other month. How much brain surgery do you plan on that specialized tools used in only particular variants of the operation will be cheap?

      I'll grant that there is a huge mark-up, because the system has removed any decent feed-back mechanism, but that's not the only reason those things are expensive.

      --

      I think we've pushed this "anyone can grow up to be president" thing too far.
    6. Re:How clean is clean enough for brain surgery? by HiThere · · Score: 1

      Wouldn't immersion in anhydrous ethyl alcohol solution of concentrated potassium hydroxide work? Of course, when we were cleaning glassware we preceded that by a bath in concentrated nitric acid, and followed it by a rinse in distilled water. We were, however, working with glassware that we wanted to remove proteins from...but we weren't worried about infection, merely analysis.

      That said, it seems to me that there are a lot of protein cleaving enzymes that could be used in a pre-treatment bath. So the problem is to ensure that the sugar-coat that they're likely to be wearing is stripped off before the cleansing agent is applied. But there are other enzymes that are good against multiple varieties of sugar, and you wouldn't need to worry about it being safe internally, so you could use the wide-spectrum ones.

      So this doesn't seem a process that's inherently impossible. Just one that's different and difficult (and expensive) to set up properly. (Of course, I'm no expert in the field.) It would probably also lengthen the turn around in how quickly you could re-use the tool. But once it's set up, it could probably be done by any lab tech with minimal training.

      --

      I think we've pushed this "anyone can grow up to be president" thing too far.
  9. "Slim risk", "rare procedures". Why is this news? by gweihir · · Score: 1

    Seriously, panic much?

    --
    Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
  10. What was the article about again? by Arzaboa · · Score: 1

    Which brain tool is the problem? The drill, the scalpel, the cracker, or the cauterizer?

    --
    What's important is that you have a faith in people, that they're basically good and smart, and if you give them tools, they'll do wonderful things with them. - Steve Jobs

    1. Re:What was the article about again? by 93+Escort+Wagon · · Score: 1

      The blackjack.

      --
      #DeleteChrome
  11. Question? by Anonymous Coward · · Score: 0

    Why do they fold? What purpose is this for? Why does folding "wrong" become harmful?

    1. Re: Question? by Anonymous Coward · · Score: 0

      A protein is only useful because of its shape. They are like knots of rubber bands, as they float in fluid they form a most natural shape. But, sometimes they have a different orientation

  12. it's more of a reminder than news by clovis · · Score: 1

    I think what this is about is that it is really old news, and because it's rare and been a long time since then, newly trained doctors don't have this on their radar.
    The much larger risk is from transfusions and graft material, a few hundred of those have occurred vs the 6 or so from surgical instruments over the last few decades.

    overview
    https://www.ncbi.nlm.nih.gov/p...
    https://www.cdc.gov/prions/cjd...

    Here's the WHO guidelines from 1999 for avoiding and decontamination
    https://www.who.int/csr/resour...

  13. Re:"Slim risk", "rare procedures". Why is this new by mentil · · Score: 1

    A 'slim risk' is one ambulance-chaser away from a "known risk that should've been mitigated."

    --
    Corruption is convincing someone that the selfless ideal is the same as their selfish ideal.
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  17. WTF? They can't even sterilise instruments? by Anonymous Coward · · Score: 0

    How difficult is that? It must be the easiest, most basic operation in any hospital, sterilising metal instruments. How can they NOT be doing it right?

    1. Re:WTF? They can't even sterilise instruments? by spth · · Score: 1

      Sterilization sufficient to kill / destroy usual pathogens like bacteria or viruses is not sufficient for prions.

      Prions are much tougher. They can easily withstand a few hundred degrees Celsius, prolonged immersion in formaldehyde or high doses of ionizing radiation.

  18. Why is this an issue? by in10se · · Score: 1

    I'm sorry, but why aren't they cleaning the equipment properly to begin with? And why is it news that using dirty equipment for surgery can cause problems for the patient?

    --
    Popisms.com - Connecting pop culture
    1. Re: Why is this an issue? by Anonymous Coward · · Score: 0

      Because it is impossible to remove all contaminants, and prions are some of the hardest. Sterilization doesnt get rid of the bad stuff, it just renders it incapable of infection. It doesnt stop prions.

  19. Sterilize my wallet by Anonymous Coward · · Score: 0

    They should sterilize my wallet after taking all my money too!

    1. Re:Sterilize my wallet by omnichad · · Score: 1

      Or at least cauterize it so nothing else comes out.

  20. "Properly" has changed by tepples · · Score: 1

    It happens when the definition of "properly" changes to accommodate new evidence about how infection spreads.

  21. explains a lot by guygo · · Score: 1

    Well that explains Ben Carson

  22. Re:"Slim risk", "rare procedures". Why is this new by Anonymous Coward · · Score: 0

    Most nuero-degenerative diseases are thought to be linked to prions. ALS, MSA, Lewie body dementia. There are many that are very low occurrence but their propagation is nearly inexplicable, what if many cases could be linked to surgery? Almost half of all adults are expected to get a nuero-degenerative disease in the course of their life. this is not really that rare of a circumstance as much as it shrouded in ignorance

  23. Re:"Slim risk", "rare procedures". Why is this new by gweihir · · Score: 1

    A slim risk in a rare case is "you get run over a car while crossing a road". Not something that prevents you from crossing roads, is it?

    --
    Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
  24. Re:"Slim risk", "rare procedures". Why is this new by gweihir · · Score: 1

    Almost half of all adults are expected to get a nuero-degenerative disease in the course of their life.

    And that is the wrong number. How many adults do get brain-surgery? Right...

    --
    Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
  25. Re: "Slim risk", "rare procedures". Why is this ne by Anonymous Coward · · Score: 0

    The âoeslim riskâ of flying is far smaller than the risk of crossing a road, but it keeps lots of people from flying.

  26. cbd by KolesnikovaAnna · · Score: 1

    Of all the medical products, I prefer only natural medicines, so I chose cbd oil tincture to treat stress. This medicine lasts a long time and I get the result very quickly. Now no problem can bring me out of balance.